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Date run 4/9/2014 10:31:31AM SAN JOi JW COUNTY ENVIRONMENTAL HEAL�DEPARTMENT <br /> Run by �/ Report#5021 <br /> Facility Information as of 4/9/2014 Pagel <br /> Record Selection Criteria: Facility ID FAGO15754 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 1 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 4 SSN/Fed Tax ID : <br /> Owner ID OW0011619 New Owner ID <br /> Owner Name JAMIE WILLIAMS <br /> Owner DBA STOCKTON RECYCLING &TRANSFER <br /> Owner Address 1533 WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-598-5309 <br /> Mailing Address 2435 E WEBER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0015754 10,185,021 <br /> Facility Name STOCKTON RECYCLING &TRANSFER STA <br /> Location 401 S LINCOLN ST <br /> STOCKTON, CA 95203 <br /> Phone 209-943-6613 x0 <br /> Mailing Address 1533 E WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 14703003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027286 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JAMIE WILLIAMS (Circe One) <br /> Account Balance as of 4/9/2014: $578.00 <br /> (circle One) <br /> Transfer to Acsve/InacNe <br /> Prognem/Element and Description Record to Employee ID and Name Status New Owner9 Delete <br /> 1921 -HMBP-Regular-Primary Location PR0523325 EE0009817-ROBERT LOPEZ CActive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO528801 EE0001421 -STACY RIVERA Active Y N A D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528800 EE0001421 -STACY RIVERA Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533990 Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,adncMedge that all site,andor project specific,PHS/EHD hourly charges assacisted with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also codify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Slate ardor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= _ Amount Paid Date / /_ <br /> Water System to be TRANSFERED: __ Amount Paid Date <br /> Payment Ty —Check Number a 'v by <br /> REHS: Date / / Account out: ate /1�/ <br /> COMMENIn <br />